mhealth Applications in CVD Prevention and Treatment Theodore Feldman, MD, FACC, FACP Medical Director, Center for Prevention and Wellness at Baptist Health South Florida Medical Director, Miami Cardiac and Vascular Institute at South Miami Hospital Clinical Associate Professor of Medicine, FIU Wertheim College of Medicine Intersection of mhealth and CVD Physical Activity Smoking Cessation Diabetes Management Weight Loss Remote EKG Monitoring Physical Activity Less than half of adults meet the 150 minutes a week of physical activity recommendation Despite well-evidenced dosedependent reductions in CVD and all cause mortality Protection from common and costly chronic conditions (including non-cvd conditions) the technology has outstripped the research, and scientists are still struggling to understand whether the monitors work as promised, how to keep people motivated to use them, and exactly what the devices are supposed to accomplish, anyway. 1
The Digital Revolution in Physical Activity Monitoring Pedometers Interventions Bravata et al. JAMA 2007;298:2296-2304 Cochrane Review: Physical Activity Evidence for pedometers in the workplace: Cochrane Database SystRev. 2013;4:CD009209 Evidence for mobile phone text messaging: Cochrane Database SystRev. 2012;12:CD007457 2
mactivetrial Intersection of mhealth and CVD Physical Activity Smoking Cessation Diabetes Management Weight Loss Remote EKG Monitoring Smoking Cessation Traditional smoking cessation tools: Pharmacotherapy: Nicotine patches, Chantix Counseling Quit line service E-cigarettes??? Unfortunately, this is still the reality!! Smoking: leading cause of preventable death in the world Accounts for 1 in 10 premature deaths in the world each year Two-thirds of current smokers want to quit Greater than one half have to quit during the last year 3
mhealth innovation aimed at smoking cessation Quitbit: lighter that tracks all your smoking Kosmo: e-cigarette that helps customize nicotine reduction program Informs you when you smoke 1 cigarette equivalent Smokio: smart phone connected vaporizer Applications for smoking cessation Abromset al. Am J PrevMed. 2011; 40(3): 279-285 iphone application: QuitSmokingCounter.com 4
Cochrane Review: Smoking cessation Mobile-phone only interventions -> increase long term quit rates Abstinence of no smoking at six months past quit date (excluding 3 lapses or up to 5 total cigarettes) Whittaker et al. Cochrane Database SystRev. 2012. Intersection of mhealth and CVD Physical Activity Smoking Cessation Diabetes Management Weight Loss Remote EKG Monitoring Diabetes 5
Are we avoiding new and treating existing cases of diabetes the best we can?? Improvements in diabetes management: Enter mhealth? Free et al. PLoSMed. 2013; 10(1): e1001362 mhealth Diabetes Control: Meta-analysis 6
Diabetes management via smart phone plug-ins & applications ibgstar: blood glucose monitoring device Tran et al. Clinical Diabetes. 2012; 30(4): 173-178 Intersection of mhealth and CVD Physical Activity Smoking Cessation Diabetes Management Weight Loss Remote EKG Monitoring Obesity Epidemic: Is it a Diet or Physical Activity Problem? More than 1/3 of U.S. Adults are obese Obesity-related conditions include heart disease, stroke, T2DM, and certain cancers, some of leading causes of preventable death There are noticeable differences in how obesity affects certain populations based on their age, race, SES, and education Obesity is higher among middle age adults: 40-59 years old (~40%) Non-Hispanic blacks have the highest age-adjusted rates of obesity (~48%) Higher income non-hispanic blacks are more likely to have obesity than those with low income Higher income women are less likely to have obesity than low-income women NO significant relationship between obesity and education in men, but in women there is a trend that those with college degrees are less likely to have obesity compared to less educated 7
U.S. Obesity Prevalence Map Weight Loss Innovation Web-based interventions (WBI): Literature review concluded modest but statistically significant weight loss when compared to no intervention or minimal intervention (4 meta-analysis) Concerns for WBI are high attrition rates Life years gained and cost effectiveness were comparable and better to in person counseling, respectively mhealth Interventions: 11/14 studies demonstrated statistically significant beneficial effects on weight and diet using mhealth SMS-only interventions In 2012, 60% of smartphoneapps downloaded were weight and exercise-related. Literature on mhealth weight loss apps is limited and at times inconsistent, BUT results do demonstrate high participant satisfaction and acceptance of mobile app intervention Studies have shown up to 4.6 kg reductions in participants but most notably have reported excellent adherence, satisfaction, and acceptability key factors in helping to maintain weight loss goals Active Video Game Interventions (AVGI): In the U.S., over 1/3 of children and adolescents are considered overweight and obese Only 29% of high school students achieve the daily recommended 60 minutes of PA Traditional video games have been reported to cause a nearly 2-fold increase in obesity AVGI increases light-to moderate-intensity PA acutely but does not signficantlycontribute to the recommended daily dosage of PA In smaller studies, children using the AVGI vs. more sedentary gaming did notice a significant weight loss of almost 4 lbs Okoroduduet al. Ann Med. 2014 mhealth Innovation Tailor-made Diets + = ACHIEVE SUCCESSFUL WEIGHT LOSS AND MANAGEMENT PROGRAMS FOR PATIENTS???? 8
Exercise to Achieve Weight Loss: Class 1B Bravata et al. JAMA 2007;298:2296-2304 Exercise + Heart Healthy Diet to Achieve Weight Loss: Class 1A!! Exercise Goals Diet Goals EACH YEAR Intersection of mhealth and CVD Physical Activity Smoking Cessation Diabetes Management Weight Loss Remote EKG Monitoring 9
AtrialFibrillation Most common sustained heart rhythm disorder and increases the risk for heart disease and stroke Causes 15-20% of ischemic strokes Prevalence of AFiband Aflutter in the U.S. is projected to increase from 3.4 to 8-12 million over the next 30-40 years AFib/Aflutter are not life threatening if treated properly Signs and symptoms vary AFibis diagnosed with ECG Diagnosing AFibearly allows for proper medical management, either via medications or procedures ENTER ALIVECOR! AliveCor AliveCor Provider Dashboard Say goodbye to the hassle of manual pulse monitoring and paper logs. You can easily and automatically share ECGs, AF episodes and symptoms you re feeling with you doctor. Easily identify the recordings you have not yet reviewed Flag noteworthy recordings View reports for a particular recording View the symptoms your patients were feeling during the recording 10